Provider Demographics
NPI:1194080085
Name:MY24HRMD
Entity type:Organization
Organization Name:MY24HRMD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WALTHER
Authorized Official - Last Name:PRUDHOMME
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:832-794-0554
Mailing Address - Street 1:12335 KINGSRIDE LN
Mailing Address - Street 2:108
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4116
Mailing Address - Country:US
Mailing Address - Phone:832-794-0554
Mailing Address - Fax:
Practice Address - Street 1:12335 KINGSRIDE LN
Practice Address - Street 2:108
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4116
Practice Address - Country:US
Practice Address - Phone:832-794-0554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty